Template

Confined Space Permit to Work

by Richard Smith, from the Community

10+

This Confined Space Permit to Work template supports safe entry and maintenance in tanks, boilers, and process equipment. It guides teams through hazard identification, isolation and lockout/tagout, ventilation and temperature checks, gas testing and continuous monitoring, PPE requirements and intrinsically safe tools, standby and rescue arrangements, communication checks, and hot work controls. It includes sections for atmospheric tests, rescue plans, authorisation and acceptance, permit expiry, and hand-back and cancellation, helping organisations standardise confined space procedures and compliance.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Confined Space Permit
Use this confined space permit to plan and authorize entry into tanks, pits, vessels, and other confined spaces. The form captures permit identifiers, work scope, location, start and finish times, isolation and lockout verification, atmospheric testing requirements and results, ventilation, PPE, communication, standby and rescue arrangements, and continuous monitoring. It includes approvals, issue, acceptance, clearance, and closure sections, plus a gas test record for oxygen, flammable gases, CO, H2S, and dust or fibers. Suitable for construction, facilities, utilities, manufacturing, and mining operations.
by Stephen Dawson, from the Community
Downloads: 0
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Template
Confined Space Pre-Entry Checklist
Use this Confined Space Pre-Entry Checklist to prepare for safe entry and support your permit to work process. It covers inductions and CSE training, risk assessment and safe work instructions, energy isolation checks, atmospheric testing and continuous monitoring, hot work controls, access and lighting, rescue planning and on-site rescuers, communications, respiratory and fall protection, ventilation, barricading, and emergency procedures. Includes PPE requirements and space for site-specific hazards.
by Stephen Crawshaw, from the Community
Downloads: 30+
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Template
V HSF038 Confined Space Permit
This V HSF038 confined space permit helps teams plan and control safe entry to confined spaces. It captures work details, location, hazards and isolations, and requires a written safe system of work with risk assessment and method statement references. The form guides atmospheric testing, ventilation, PPE, communication, rescue arrangements and equipment checks. It records authorization by a permit coordinator, supervisor briefing and receipt, completion of work and permit cancellation. Use this checklist style permit to document controls and compliance before, during and after entry.
by Olivia Blazier, from the Community
Downloads: 10+
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Template
Confined Space Assessment
This confined space assessment checklist helps teams classify spaces, identify hazards, and verify permit-required entry controls. Review atmospheric, engulfment, and configuration hazards; specify monitoring, ventilation, PPE, retrieval, and communication needs; confirm rescue arrangements; and document SDS review, isolation, testing, and hot work permits. Capture comments and signatures to ensure compliance and safer confined space operations.
by Ralpat98 User, from the Community
Downloads: 0
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Confined Space Permit to Work

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